Download Peripheral IV Therapy Policy

Fluid & Medication Management
Peripheral Intravenous Therapy
Peripheral intravenous therapy
Contents
Policy ....................................................................................................................................................... 1
Purpose ................................................................................................................................................... 1
Scope ....................................................................................................................................................... 1
Associated documents ............................................................................................................................ 2
Requirements for Level 1 Certification Attainment and Recertification ................................................ 2
General IV Procedural Requirements ..................................................................................................... 2
Child Health Specific IV Infusion Requirements.................................................................................. 3
Line Changes and Labelling/Identification .......................................................................................... 3
Flushing and Cannula Management ................................................................................................... 4
Cannula Rotation/Removal ................................................................................................................. 5
Intermittent Disconnection of an IV Giving Set .................................................................................. 5
Phlebitis Scoring ...................................................................................................................................... 5
Electronic Infusion Pump requirements ................................................................................................. 7
Documentation requirements ................................................................................................................ 7
Other IV Therapy considerations ............................................................................................................ 7
Measurement and Evaluation................................................................................................................. 8
References .............................................................................................................................................. 8
Policy
Staff and approved persons with 1st Level certification in peripheral
IV management will adhere to the below requirements
Purpose
To guide staff on the scope of peripheral IV therapy and safe,
appropriate management.
Scope
All 1st level certificated persons, Medical Practitioners and Approved
persons and all staff involved in the double independent checking
role with peripheral IV medication/fluid.
The latest version of this document is available on the CDHB intranet/website only.
Printed copies may not reflect the most recent updates.
Authorised by: CMO, EDON
Ref: 4749
Page 1 of 8
Issue Date: December 2015
Be reviewed by: December 2018
Fluid & Medication Management
Peripheral Intravenous Therapy
Associated documents
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Roles and Responsibility Policy Vol 12
CDHB Fluid and Medication Checking Procedure
Self-Learning Package (SLP) for IV Level 1 Certification
Infection Prevention and Control policy Vol 10
British National Formulary (BNF)
Notes on Injectable Drugs (NZ Hospital Pharmacists Association
Inc.)
Royal Children's Hospital Melbourne, Paediatric pharmacopaedia
http://www.rch.org.au/pharmacopoeia New Ethical’s Catalogue
(MIMS)
Patient Identification policy Vol 11
Health Care Waste - Which bin does it go in (ref 1191)
IV link site
Requirements for Level 1 Certification Attainment and
Recertification
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Successful completion of:
o The CDHB Level 1 certification programme, both theory and
practical components, on orientation to the CDHB
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Certification is required to be completed within four months of
commencing employment
Exception
Specialist Mental Health where certification is not required
It is the individuals responsibility to maintain their practice
competency as there is no requirement for recertification
If the staff member or approved person has not practiced IV
management for over 12 months they are no longer considered IV
certificated and must re certificate when they return to an IV
management role
Level 1 certificated staff and approved persons must adhere to the
Roles and Responsibilities Policy Vol 12
General IV Procedural Requirements

Roles and responsibilities for staff and approved persons involved
in medication and fluid management are outlined in the Roles and
Responsibilities policy
The latest version of this document is available on the CDHB intranet/website only.
Printed copies may not reflect the most recent updates.
Authorised by: CMO, EDON
Ref: 4749
Page 2 of 8
Issue Date: December 2015
Be reviewed by: December 2018
Fluid & Medication Management
Peripheral Intravenous Therapy
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Use approved methods of medication and fluid reference (as per
Associated Documents) or contact pharmacy
A non-coring blunt needle will be used to draw up fluid from a poly
amp
A filter needle will be used when drawing up contents of a vial/glass
ampoule
With incremental dosing e.g. Opioids IV. Attach patient
identification information and an additive label to the syringe. Use
the same administrator for each incremental dose, and perform the
double independent check procedure prior to each subsequent
dose. A new syringe cap is to be attached after each incremental
dose. Discard the syringe at the end of the shift/patient procedure.
Controlled Drugs must be returned to the drug safe between
incremental doses where the drug and patient will not be under
constant surveillance by the administrator (e.g. ward settings).
Refer to the Controlled and Recorded Drug Register
Documentation and Monitoring Requirements Policy for information
on discarding unused drugs Policy
A new sterile cap(combi loc device) must be applied to continuous
infusions which have been temporarily stopped for short periods of
time to ensure asepsis is maintained
Child Health Specific IV Infusion Requirements
 An inline buretrol must be attached to the line
 The buretrol will have a maximum fluid volume of no more than 2
hours at any one time (to minimise the risk of inadvertent fluid or
medication bolus)
 All fluid will be delivered via a volumetric pump
 These requirements also apply to Paediatric CVAD use
Line Changes and Labelling/Identification
 Label all IV lines with time and date of commencement
 Use an additive label where medication has been added to either
the syringe or IV infusion bag
 Where multi drug infusion/administration is in progress all
administration set lines must have the drug identified on the distal
end of each line used
 Always trace tubing from the patient to the point of origin before
connecting or bolusing
 Apply a patient label to the administration infusion line in situations
where the patient will be disconnected/separated from the infusion
The latest version of this document is available on the CDHB intranet/website only.
Printed copies may not reflect the most recent updates.
Authorised by: CMO, EDON
Ref: 4749
Page 3 of 8
Issue Date: December 2015
Be reviewed by: December 2018
Fluid & Medication Management
Peripheral Intravenous Therapy
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temporarily, to ensure that the line correlates to the correct patient
on reconnection
Label incremental dosing syringes with the patient ID information
Intermittent IV infusions require line/giving set changes after each
administration
IV Giving Sets
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An IV giving set that is in use to infuse fluid or medication via a
peripheral IV cannula must be disconnected and discarded and not
reconnected to a newly inserted or existing CVAD.
Reconnecting the existing IV giving set poses a risk for infection
which compromises the patient, CVAD and the prescribed
treatment.
Continuous IV infusions require a line/giving set change at least
every 72 hours (Exceptions: where specific medication
requirements exist e.g. Blood and Blood products (blood filters
changed every 8 hrs.),e.g. Ciclosporin and TPN lines changed
every 24hrs
Refer to Drug Information resources, pharmacy or other policy for
clarification where required.
Flushing and Cannula Management

Peripheral cannulae must be removed/resisted
o
o
no less frequently than every 72hrs (Exception - Child Health)
at the first signs of phlebitis score of 2
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Where an extension set has not been attached at insertion and the
patient requires more than 24hrs of IV therapy, an extension set must
be attached aseptically. Extension sets reduce the risk of mechanical
phlebitis
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When flushing an extension set attached to the end of a cannula, use
the clamp to provide positive pressure at the end of the flush to assist in
avoiding red cell occlusion of the cannula
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A flush pre and post bolus/intermittent infusion administration must
occur with at least 5 mLs IV 0.9% Sodium Chloride. These do not
require prescribing
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With Intermittent medication therapy infusions the line must be flushed
post administration with 30 mLs of 0.9% Sodium Chloride to ensure the
patient receives the whole dose
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Where a 30 mL infusion line flush is required post administration this
flush this will not require prescribing, you are administering the rest of
the drug dose not the flush
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The recommended method for flushing an intermittent infusion line is to
attach a 100ml bag of 0.9% Sodium Chloride and infuse 30 mLs of this
The latest version of this document is available on the CDHB intranet/website only.
Printed copies may not reflect the most recent updates.
Authorised by: CMO, EDON
Ref: 4749
Page 4 of 8
Issue Date: December 2015
Be reviewed by: December 2018
Fluid & Medication Management
Peripheral Intravenous Therapy
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Cannulae must be flushed with 0.9% Sodium Chloride at least once per
shift to maintain patency. When no IV medication/fluid administration is
prescribed, the administrator must document this flush in the medication
chart to ensure traceability
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Cannulae must be flushed at least once per 8 hrs. with an established
interval flushing plan recorded within the patients care plan
Documentation
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IV 0.9% Sodium Chloride flushes do not require documentation when
used prior and post bolus or for intermittent therapy access/de access
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Document this once per 8hr flush to keep patency on the drug chart
Exception: Flushes will be recorded on the fluid balance chart where
the patient is haemo dynamically compromised or required as part of
their Fluid Balance management
Cannula Rotation/Removal
 The cannula site must be rotated /resited every 72hrs in adults or at
the first sign of phlebitis (score = or above 2) or with any other
complication.
 Exception: Child Health where cannulae are only rotated/resited
when clinically indicated. Refer to Neonatal policy for neonates
 All community placed cannulae need to be identified and
documented in the clinical notes. The cannula must be re sited as
soon as practicable. Documented rationale is required in the
clinical notes if the cannula has not been resited within 24 hours.
 Use the designated ‘IV pressure pads’ upon removal of the
cannula, removing the pad after 2 hours.
Intermittent Disconnection of an IV Giving Set
 A new sterile cap (combi loc device) must be aseptically attached
to the end of the administration set when disconnecting the system
from the cannula
 Do not attach the exposed end of the administration set to a port on
the same infusion set (‘looping’) – this poses a risk of
contamination
Phlebitis Scoring
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Phlebitis scoring will be performed on each occasion prior to
accessing the cannula or at least every 8hrs
Patients with infusions who have been assessed as understanding
the complications of the therapy will have their site monitored at
each point of contact, this rationale must be documented in the
clinical notes
The latest version of this document is available on the CDHB intranet/website only.
Printed copies may not reflect the most recent updates.
Authorised by: CMO, EDON
Ref: 4749
Page 5 of 8
Issue Date: December 2015
Be reviewed by: December 2018
Fluid & Medication Management
Peripheral Intravenous Therapy
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With infusions, sites will be monitored hourly and the phlebitis score
documented for all children and adult patients who are unable to
understand or communicate side effects of the therapy
Where particular medication infusion instructions/policy exists
follow these instructions for phlebitis assessment and
documentation
Phlebitis scores are to be documented on the patients Observation
Chart for bolus therapy or on the Fluid Balance Chart for infusion
therapy
Actions and rationale will be documented in the patients clinical
notes where a phlebitis score is = or above 1
Picture
Score
0 No symptoms
Actions
No signs of phlebitis
Observe cannula
+1 Erythaema at
access site with
our without pain
Possible 1st signs
phlebitis
+2 Pain at
access site with
erythaema and /or
oedema
Early phlebitis
+3 Pain at
access site with
erythaema and/or
oedema, streak
formation,
palpable cord
Moderate phlebitis
Observe cannula
Resite cannula & treat
site
Resite cannula & treat
site.
Take swab & send to
lab
The latest version of this document is available on the CDHB intranet/website only.
Printed copies may not reflect the most recent updates.
Authorised by: CMO, EDON
Ref: 4749
Page 6 of 8
Issue Date: December 2015
Be reviewed by: December 2018
Fluid & Medication Management
Peripheral Intravenous Therapy
+4 Pain at
access site with
erythaema, Streak
formation,
Palpable venous
cord 2 cm in
length, purulent
drainage (in Child
Health less or
equal to 1cm)
Advanced
thrombophlebitis
Resite cannula & treat
site.
Take swab & send to
lab
Electronic Infusion Pump requirements

Where Guardrails have been incorporated into infusion devices the
technology will be used for all drug infusions listed within the required
drug library profile set up for that area.
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Any changes to the dose/rate or time delivery of the infusion should be
checked by 2 authorised persons (refer to the Roles and
Responsibilities policy Vol 12) and signed by both persons to confirm
the correct patient and dose/rate.
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Pumps must have the alarm system activated at all times
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In Child Health and Neonates ensure pump pressure settings are
correct for the patient’s age and infusion requirements
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Clean pumps with detergent and water and disinfect if required as per
Infection Prevention and Control Policy
Pumps must be plugged into the mains power at all times when in the
patient is not mobilising or when not in use
Documentation requirements
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See above for labelling lines/medication/fluids and phlebitis scoring
documentation
Therapy effects, variances or complications must be documented
within the patients clinical notes
Other IV Therapy considerations
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Refer to the Central Venous Access Device (CVAD) policy for CVAD
management requirements
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Refer to Fluid Balance Management Policy in regard to recording IV
fluid therapy Vol 12
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For specific medications/fluids refer to local policy or the specific policy
in Vol 12
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For incremental opioid administration refer to the policy in Vol 12
The latest version of this document is available on the CDHB intranet/website only.
Printed copies may not reflect the most recent updates.
Authorised by: CMO, EDON
Ref: 4749
Page 7 of 8
Issue Date: December 2015
Be reviewed by: December 2018
Fluid & Medication Management
Peripheral Intravenous Therapy
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Refer to Verbal Orders Policy Vol 12 for the documentation of IV verbal
orders
Measurement and Evaluation
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Certification database will hold certified staff and approved persons
Clinical practice observations will be performed in all areas of
peripheral IV use. The managers will be responsible for
implementing improvements with the overall governance of the
CDHB and West Coast IV Resource Group
Incident management reviews
References
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Royal College of Nurses – Standards for Infusion Therapy, 3rd
Edition , January 2010
Intravenous Nursing New Zealand – Infusion Therapy Standards of
Practice 2012
CDC Guidelines for the prevention of Intravascular CatheterRelated infections,2011
Journal of Infusion Nursing – Infusion Standards of Practice revised
2011
Becan-McBride, K, 1999 “Laboratory Sampling: Does Process
Affect the Outcome?; Journal of Intravenous Nursing, 22,137-142
(111
DHBNZ Quality Safe Use of Medications Alert 9 December 2009
Intravenous Pump and Infusion Practices
www.safeuseofmedicines.co.nz
Medicines Act (1981, and amendments)
Policy Owner
IV Educator Professional Development Unit
Policy Authoriser
Chief Medical Officer & Executive Director of Nursing
Date of Authorisation
15 December 2015
The latest version of this document is available on the CDHB intranet/website only.
Printed copies may not reflect the most recent updates.
Authorised by: CMO, EDON
Ref: 4749
Page 8 of 8
Issue Date: December 2015
Be reviewed by: December 2018